- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.24 / $762.91 / $1,004.46
| Professional | | $752.24 | $762.91 | $1,004.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,006.39 / $5,006.39 / $5,006.39
| Facility | | $5,006.39 | $5,006.39 | $5,006.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.00 / $1,724.00 / $2,609.00
| Professional | | $1,437.00 | $1,724.00 | $2,609.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $862.39 / $1,296.95 / $2,098.16
| Professional | | $862.39 | $1,296.95 | $2,098.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.34 / $1,372.68 / $2,397.06
| Professional | | $813.34 | $1,372.68 | $2,397.06 |